05/09/2026
“He Will Eat When He Gets Hungry”: Why That Statement Can Be Dangerous for Some Children.
Before I became an Occupational Therapist, I truly did not understand the difference between picky eating and problem feeding.
Like many people, I assumed that a child who refused certain foods simply didn’t like them. As a child myself, I was a picky eater. There were foods I avoided because they did not look appealing to me, but I could still tolerate them being around me or on my plate.
That is what we often see with picky eaters.
Picky eaters usually have preferences. They may refuse certain foods, but if presented with multiple choices, they will often find something they are willing to eat.
They can typically tolerate food on their plate, touch it, or remain around it even if they choose not to eat it.
Problem feeding is very different.
Feeding is one of the most complex human functions. It involves multiple body systems and developmental processes, sensory processing, oral-motor skills, gastrointestinal function, behavior, emotional regulation, posture, coordination, and even social interaction.
Eating is not simply about hunger or choice. It involves how food looks, smells, tastes, sounds, and feels in the mouth and body.
Recently, I worked with a two-year-old child who did not chew food. The parents reported that getting anything near his mouth was extremely difficult. Dental visits were nearly impossible. Tooth brushing was a daily struggle. He would not allow anyone near his mouth.
Through therapeutic play and trust-building, I was eventually able to assess his oral structures. The child demonstrated significant oral sensory defensiveness and low oral muscle strength. He avoided anything touching the inside of his mouth, attempted to chew only with his front teeth, and would not tolerate oral-motor tools. Even introducing the tool near his mouth triggered distress.
What does this tell us?
This was not simply a “picky eater.” This was a child experiencing significant sensory motor and feeding challenges.
The child became extremely distressed at the mere sight of certain foods on his tray — bananas, cereal, and other foods placed in front of him. He escalated into panic-like behaviors and immediately threw every item off his tray and highchair to remove them from his environment.
The only thing he consistently accepted was milk.
This is why feeding therapy must be approached holistically.
Occupational Therapists do not only address utensil use or self-feeding skills. We also address:
• Oral sensory processing
• Motor planning and chewing skills
• Sensory defensiveness
• Regulation and behavior during meals
• Positioning and postural control
• Food exploration and tolerance
• Family coaching and mealtime routines
Sometimes feeding difficulties are not behavioral defiance.
Sometimes they are rooted in the nervous system itself.
If you have a child who may be experiencing these challenges, please do not assume “they will eat when they get hungry.”
Some children with significant feeding difficulties may continue restricting intake despite hunger because eating itself feels distressing or unsafe to their nervous system.
Early evaluation and intervention can make a tremendous difference in a child’s feeding journey, nutrition, development, and overall quality of life.
Dr. Ezii (05/09/2026)
